An invasive tubular device can be guided under ultrasonographic visualization by an apparatus that numerically measures an insertion angle and a length of the invasive tubular device to reach a tissue target. Insertion angle of an invasive device can also be adjusted to various positions of an ultrasound transducer in relation to a center of the tissue target. The apparatus comprises a positioning guide for an invasive tubular device through which the invasive tubular device passes toward a tissue target and a positioning guide controller which adjusts angulation of the positioning guide by using ultrasonographic visual information or by calculated numerical information of a set of insertion angle and depth of the invasive tubular device to reach the tissue target. The positioning guide is configured to be coupled with the positioning guide controller in a way to separate the positioning guide, before inserting the invasive tubular device toward the tissue target, from the positioning guide controller following localization and angulation of the positioning guide. It would be technically advantageous for a majority of applications to have a free-standing positioning guide that would verify a correct positioning of the positioning guide before inserting invasive tubular devices by additional imaging modalities such as computerized tomogram or by repeating ultrasonogram. The free-standing positioning guide reversibly attached to a skin overlying the tissue target allows a few invasive tubular devices to be used interchangeably through the same positioning guide toward the same tissue target. For example, placement of a large vascular catheter in a blood vessel usually requires a probing needle, a guidewire that uses Seldinger technique to reach a target site, a dilator to widen a tissue leading up to a vascular wall for inserting a vascular catheter and a vascular catheter. Attachment of the free-standing positioning guide to the skin overlying the target frees an operator to use both hands for a series of procedures for manipulating these devices, without a need to hold the ultrasound probe by one hand.
There are other applications of the positioning guide, however, which would best be accomplished by an apparatus of a positioning guide coupled with a positioning guide controller throughout manipulations of invasive devices. In-process visualization of insertion procedures of invasive devices would be required for small lesions, lesions located near vital structures or lesions that move during invasive procedures by physiologic bodily function such as breathing, heartbeat or pulsating blood vessels to increase accuracy of the insertion and to reduce chances of potential complications of the procedure. An invasive device placed in the positioning guide can be visualized and monitored by the positioning guide controller which houses an ultrasound probe and holds the positioning guide it controls for insertion angle and depth. Multiple samplings from a few individual sites in a single lesion can be expedited by a coupled apparatus as all interested sites are visualized by a positioning guide controller in an ultrasonographic field and the positioning guide controller holding a positioning guide can select preferred sites for a series of sequential invasive procedures. One crucial advantage of using the coupled configuration of the apparatus over a free-standing positioning guide comes from a need to abort or change an invasive procedure after the procedure was initiated. There would be several reasons to abort or change invasive procedures even after an invasive device was inserted into a tissue, including an unexpected heterogeneity in consistency of the tissue that forces changes in an insertion path, a wrong insertion path that leads the invasive device to an area off a tissue target or an incidental damage to vital structures such as blood vessels. In these circumstances, a free-standing positioning guide once deployed to a skin region by a positioning guide controller will be wasted. In contrast, a positioning guide yet attached to and controlled by a positioning guide controller will be able to function until completion of an intended procedure.